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BCBS/Anthem and State Lines

  • 1.  BCBS/Anthem and State Lines

    Posted 06-07-2021 13:15
    Rome Radiology Group is based in Rome, GA.  Rome, GA lies against the GA AL state line.  Up until 3 years ago, the Group only provided services within GA.  Three years ago, one of our GA hospitals acquired another smaller hospital just across the state line in AL   With limited onsite presence, the Group began reading nearly all of the studies from this newly acquired hospital in GA.  The Group is contracted with BCBSofGA (an Anthem BCBS), but we are not contracted with BCBSofAL (an independent BCBS).  I contacted BCBSofAL and was directed to bill BCBSofGA for all our services.  This seems to work nicely and claims are paid accordingly.  We are now looking at the possibility of moving deeper into the State of AL.  I can't get BCBSofGA or BCBSofAL to confirm that I should continue billing BCBSofGA for other hospitals located in AL.  I wasn't sure if the original AL hospital being owned by a GA hospital made any difference or if reading location mattered.

    Hopefully, another group out there lies on a state line too and is experiencing the same problems.  Any available direction or comments on the following:
    Do you contract with multiple BCBS plans if you cross a state line?
    Does Commercial BCBS care where a rad actually sits?

    Thanks for any help of suggestions......Chris

    ------------------------------
    R. Christopher Sluder CPA
    Administrator
    Rome Radiology Group
    Rome GA
    (706) 291-2661
    ------------------------------


  • 2.  RE: BCBS/Anthem and State Lines

    Posted 06-07-2021 13:57
    Hi Chris

    We operate across two different BCBS plan service areas, and we contract with both plans.  Around here, the rule is we bill the BCBS plan that covers the location where the patient was seen, regardless of which plan the patient has their policy with.  We report the location where the patient was seen on the claim.  The reading location isn't relevant.

    I would try reaching higher up the food chain with Alabama.  It would be surprising to me if they don't want to contract with you directly, and I would expect hospitals to want that too.  Hospitals can probably help connect you with the right person.

    Hope this helps!

    Dave

    ------------------------------
    David Smith FACMPE
    Executive Director
    United Imaging Consultants
    Mission KS
    (785) 393-8387
    ------------------------------

    Original Message


  • 3.  RE: BCBS/Anthem and State Lines

    Posted 06-07-2021 14:06

    I agree with David on this. When I billed for a large rad group here in MS and we had clinics and hospital is counties that bordered AL we had to contract with BCBS AL.

    BCBS AL has certain plans that pays differently when a service is provided in state, in a contiguous county, or in another state.

    With BCBS AL you always have to bill based on where the service was performed not where it was read. BCBS AL actually credentials providers PER location/site and you get a different provider number for each location/site.

     

     

     

     

    RESPECTFULLY, 

     

    Rick D Gladish, RCC, CPC

    MD Revenue Management, LLC

    111 Troy St STE F

    Tupelo, MS 38804

    ph 662-620-7102 fax 662-620-7106

    email: rick@mdrm.us

    website: www.mdrm.us

     

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    Original Message


  • 4.  RE: BCBS/Anthem and State Lines

    Posted 06-10-2021 14:29

    Dave Smith,

    You said where the study is interpreted is irrelevant.  I was under the impression that medicare requires you to document the state from which you are reading if you are not in the same state as where the study is done.  That payments are based on rates in the state in which it is read regardless of where it was done.

    In fact our billing company has specifically told us that if we are going to have rads reading from out of state we need to apply for a medicare license in that state and each report needs to state where it was being read so they know how to process it.

    Is this not the way you understand it to be?

    Thanks!
    Greg



    ------------------------------
    Gregory Benke MD
    Diagnostic Radiologist/Co-Chair of BPA Radiology
    Brevard Physician Associates
    Melbourne FL
    (321) 837-3820
    ------------------------------

    Original Message


  • 5.  RE: BCBS/Anthem and State Lines

    Posted 06-10-2021 14:44

    Greg – I think you are confusing Payer guidelines. Each Payer has their own set of guidelines. David was specifically discussing Blue Cross Blue Shield and it seems you are referring to CMS guidelines.....

     

    Keith E. Chew, MHA, CMPE, FRBMA

    Principal

    Consulting with Integrity

    18 Hawks Nest

    Chatham, IL     62629

    217-971-5293

     




    Original Message


  • 6.  RE: BCBS/Anthem and State Lines

    Posted 06-10-2021 14:48

    You're right.  I meant CMS.  Forgot the original post was BCBS.

    Thanks,

    Greg



    ------------------------------
    Gregory Benke MD
    Diagnostic Radiologist/Co-Chair of BPA Radiology
    Brevard Physician Associates
    Melbourne FL
    ------------------------------

    Original Message


  • 7.  RE: BCBS/Anthem and State Lines

    Posted 06-10-2021 14:53

    Greg – It's easy to do..... Payers don't make any of our lives easier......

     

    Keith E. Chew, MHA, CMPE, FRBMA

    Principal

    Consulting with Integrity

    18 Hawks Nest

    Chatham, IL     62629

    217-971-5293

     




    Original Message


  • 8.  RE: BCBS/Anthem and State Lines

    Posted 06-22-2021 16:33
    I completely agree with the logic the BCBS plan where the exam is being performed should be the BCBS plan where the claim should be filed.  This can easily be tested by looking at a nationwide nighthawk provider.  I'm sure these companies don't file claims with the BCBS plan where their rads are sitting.  They file claims where the facility is located.  We do this for with our own nighthawk service.

    That being said, this is the BCBSofAL response I got via the Alabama facility:
    For reads done in GA they will need to file their claims to Blue Cross Blue Shield of GA.  If they read in Alabama they will need to be credentialed with us (Alabama) and submit the claims to Blue Cross Blue Shield of Alabama.  I hope this helps. 

    This is from a Senior Provider Network Services Consultant with BCBSofAL.  And this response is consistent with the direction we were given by BCBSofAL back in 2018.  Our reading situation (AL facility performing exams and exams are read in GA)  was explained in detail to BCBSofAL.  They have now given the same directions twice.

    The trick here will be dividing out what is done in GA vs. AL.  We can track via workstation name, but I'm sure we will encounter issues.

    My update......Chris


    ------------------------------
    R. Christopher Sluder CPA
    Administrator
    Rome Radiology Group
    Rome GA
    (706) 291-2661
    ------------------------------

    Original Message


  • 9.  RE: BCBS/Anthem and State Lines

    Posted 06-23-2021 08:20
    We are based in Texas and going to be covering a small hospital in Oklahoma just across the state line.  I was told the same thing by BCBS.  That for this site any work we do onsite in Oklahoma is to be billed to BCBS OK but any work we do offsite from Texas we will bill to BCBS TX.   

    Thanks
    Dave Walker
    Radiology Associates of North Texas

    ------------------------------
    Dave Walker
    Director of Revenue Cycle
    Radiology Associates of North Texas
    Fort Worth TX
    (817) 321-0386
    ------------------------------

    Original Message


  • 10.  RE: BCBS/Anthem and State Lines

    Posted 06-23-2021 11:53
    Dave,
    Be careful with BCBS OK.  They refuse to credential tele readers across state lines so if you are reading Oklahoma studies from out of state you are out of luck. I'm told that the internal BCBS OK policy is to credential based on the address established for the OK Medical license.  ie. if your docs OK license address is in Texas then you won't get credentialed by BCBS OK. This will lead to OON denials.  Ludicrous but as Keith says  payers don't make our lives easier.

    Agree that you always file to Oklahoma BCBS if the technical service is performed in OK.  Out of state BCBS plans coordinate with BCBS OK to pay those claims.

    Hope that helps.
    Neale

    ------------------------------
    Neale Pashley
    Vice President, Partner Services
    Collaborative Imaging
    Plano TX
    ------------------------------

    Original Message


  • 11.  RE: BCBS/Anthem and State Lines

    Posted 06-24-2021 11:43
    Neal,

    I agree with you.  One of the other considerations is that BCBS has been changing language in their contracts that could create issues with surprise billing as claims flow through the BCBS network vs. in-state.

    Chris - as indicated by others, I would look to elevate the level to a higher level person, if possible, and become in-network with GA.

    ------------------------------
    Anthony Werner
    CliftonLarsonAllen LLP
    Minneapolis MN
    (612) 397-3061
    ------------------------------

    Original Message


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